insurance bad faith ● consumer class actions

I was able to obtain a victory in the Ninth Circuit in this Salyers v. Metropolitan Life Insurance Company. The Court held that Met Life had waived its right to require evidence of insurability when it had never asked for such a form to be completed and had deducted premiums for the life insurance coverage requested. The Court also adopted the common law rules of agency into ERISA, holding that when an employer accepts premiums and applications for coverage from the employees, the employer is acting as an agent of the insurance company.

We received a favorable decision in an Aetna disability case today, where the Court found that Aetna's denial was unreasonable and that it ignored the evidence in its own files: "It is puzzling that Aetna’s explanation for its denial in the letter sent to Plaintiff states that neither Dr. Wang nor Dr. Mehta provided “submitted any clinical rationale or any resent [sic] test results,” when both doctors included test results, including the recent MRI results, and all of Plaintiff’s medical records in faxes submitted to Aetna in support of their clinical assessments finding Plaintiff permanently disabled."